501
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Hng M, Zhao SS, Moots RJ. An update on the general management approach to common vasculitides. Clin Med (Lond) 2020; 20:572-579. [PMID: 33199323 DOI: 10.7861/clinmed.2020-0747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary systemic vasculitides (PSV) are multisystem diseases associated with high morbidity and mortality, particularly if not treated in a timely manner. In recent decades, clinical trials have delivered considerable evidence to underpin optimal diagnostic and therapeutic approaches. This article provides a brief overview of PSV in adults, focusing on the latest updates and recommendations for the management of antineutrophil cytoplasmic antibody-associated vasculitis and giant cell arteritis.
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Affiliation(s)
| | - Sizheng S Zhao
- Aintree University Hospital, Liverpool, UK and University of Liverpool, Liverpool, UK
| | - Robert J Moots
- Aintree University Hospital, Liverpool, UK and Edge Hill University, Liverpool, UK
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502
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Buttgereit F. Glucocorticoids: surprising new findings on their mechanisms of actions. Ann Rheum Dis 2020; 80:137-139. [PMID: 33162396 DOI: 10.1136/annrheumdis-2020-218798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Frank Buttgereit
- Charité University Medicine, Department of Rheumatology and Clinical Immunology, Berlin, Germany
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503
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Montolio-Chiva L, Valls-Pascual E, Ortiz-Seller A, Balaguer-Muñoz D, Albert-Fort M, Alegre-Sancho JJ. Bilateral posterior scleritis as a form of presentation of giant cell arteritis. Joint Bone Spine 2020; 88:105101. [PMID: 33171310 DOI: 10.1016/j.jbspin.2020.105101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Lydia Montolio-Chiva
- Rheumatology Department, Universitary Peset Doctor Hospital, Gaspar Aguilar Avenue, 90, 46017 Valencia, Spain.
| | - Elia Valls-Pascual
- Rheumatology Department, Universitary Peset Doctor Hospital, Gaspar Aguilar Avenue, 90, 46017 Valencia, Spain
| | - Amparo Ortiz-Seller
- Ophthalmology Department, Universitary and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - David Balaguer-Muñoz
- Nuclear Medicine Department, Universitary Peset Doctor Hospital, 46017 Valencia, Spain
| | - Mara Albert-Fort
- Ophthalmology Department, Universitary Peset Doctor Hospital, 46017 Valencia, Spain
| | - Juan José Alegre-Sancho
- Rheumatology Department, Universitary Peset Doctor Hospital, Gaspar Aguilar Avenue, 90, 46017 Valencia, Spain
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504
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Sebastian A, Kayani A, Prieto-Pena D, Tomelleri A, Whitlock M, Mo J, van der Geest N, Dasgupta B. Efficacy and safety of tocilizumab in giant cell arteritis: a single centre NHS experience using imaging (ultrasound and PET-CT) as a diagnostic and monitoring tool. RMD Open 2020; 6:e001417. [PMID: 33161376 PMCID: PMC7856116 DOI: 10.1136/rmdopen-2020-001417] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/03/2020] [Accepted: 10/21/2020] [Indexed: 11/03/2022] Open
Abstract
Tocilizumab (TCZ), an IL-6 receptor blocker, is approved for relapsing, refractory giant cell arteritis (GCA). We report real-life clinical experience with TCZ in GCA including assessment of responses on imaging (ultrasound (US) and 18F-Fluorodeoxyglucose Positron Emission Tomography-computed Tomography (18FDG-PET-CT)) during the first year of treatment. We included 22 consecutive patients with GCA treated with TCZ where EULAR core data set on disease activity, quality of life (QoL) and treatment-related complications were collected. Pre-TCZ US and 18FDG-PET/CT findings were available for 21 and 4 patients, respectively, where we determined the effect on US halo thickness, temporal and axillary artery Southend Halo Score and Total Vascular Score on 18FDG-PET-CT. The 22 patients with GCA (10 cranial, 10 large vessel, 2 both) had a median disease duration of 58.5 (range, 1-370) weeks prior to initiation of TCZ. Half had used prior conventional synthetic disease-modifying antirheumatic drug (csDMARDs). TCZ was initiated for refractory (50%), ischaemic (36%) or relapsing (14%) disease. Median follow-up was 43 (12-52) weeks. TCZ was discontinued due to serious adverse events (SAEs) in two patients. On treatment with TCZ, 4 discontinued prednisolone, 11 required doses ≤2.5 mg, 2 required daily dose of 2.5-5 mg and 5 needed prednisolones ≥5 mg daily. QoL improved by 50%. Total US halo thickness decreased in 38 arterial segments, median temporal artery Halo Score decreased from 11 to 0, axillary artery Halo Score remained stable. Median Total Vascular Score on FDG-PET/CT reduced from 11.5 to 6.5. In our experience, TCZ showed an excellent response with acceptable safety in GCA, with improvement on US and FDG-PET/CT imaging.
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Affiliation(s)
- Alwin Sebastian
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea,UK
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester, UK
| | - Abdul Kayani
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea,UK
| | - Diana Prieto-Pena
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea,UK
- Rheumatology, Marques De Valdecilla University Hospital, Santander, Spain
| | - Alessandro Tomelleri
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea,UK
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Madeline Whitlock
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea,UK
| | - Jonathan Mo
- Radiology, Southend Hospital NHS Trust, Westcliff-on-sea,UK
| | - Niels van der Geest
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea,UK
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester, UK
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505
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Zhu K, Born DW, Dilli E. Secondary Headache: Current Update. Headache 2020; 60:2654-2664. [PMID: 33078413 DOI: 10.1111/head.13986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this paper is to review some of the causes of secondary headache particularly focusing on the subcategories of secondary headache in the International Classification of Headache Disorders, 3rd edition, the clinical features of these headaches, and their associated features and management. OVERVIEW Headache attributed to trauma or injury to the head and/or neck, headache attributed to cranial or cervical vascular disorder, headache attributed to non-vascular intracranial disorder, headache attributed to a substance or its withdrawal, headache attributed to infection, headache attributed to disorder of homeostasis, and headache or facial pain attributed to disorder of the cranium, neck, eye, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure are discussed in this paper. DISCUSSION Headache is a common symptom of multiple medical conditions. Although a minority of headache patients have a secondary basis for their headaches, it is important to identify clinical features of secondary headache disorders including both the headache and non-headache features of the condition, diagnose the secondary etiology correctly, and treat them appropriately.
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Affiliation(s)
- Kai Zhu
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Dawson W Born
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Esma Dilli
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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506
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Yip A, Jernberg ET, Bardi M, Geiger J, Lohne F, Schmidt WA, Myklebust G, Diamantopoulos AP. Magnetic resonance imaging compared to ultrasonography in giant cell arteritis: a cross-sectional study. Arthritis Res Ther 2020; 22:247. [PMID: 33076985 PMCID: PMC7574248 DOI: 10.1186/s13075-020-02335-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/01/2020] [Indexed: 01/18/2023] Open
Abstract
Background There has been a shift in recent years to using ultrasound (US) and magnetic resonance imaging (MRI) as first-line investigations for suspected cranial large vessel vasculitis (LVV) and is a new recommendation by the EULAR 2018 guidelines for imaging in LVV. This cross-sectional study compares the performance of US and MRI and contrast-enhanced magnetic resonance angiography (MRA) for detecting vasculitis in patients with giant cell arteritis (GCA). Methods Patients with new-onset or already diagnosed GCA were recruited. The common temporal arteries and supra-aortic large vessels were evaluated by US and MRI/MRA. Blinded experts read the images and applied a dichotomous score (vasculitis: yes/no) in each vessel. Results Thirty-seven patients with giant cell arteritis (GCA) were recruited. Two patients were excluded. Of the remaining patients, nine had new-onset disease and 26 had established disease. Mean age was 71 years, and median C-reactive protein (CRP) was 7.5 mg/L. The median time between US and MRI was 1 day. Overall, US revealed vasculitic changes more frequently than MRI (p < 0.001). US detected vascular changes in 37% of vessels compared to 21% with MRI. Among patients with chronic disease, US detected vascular changes in 23% of vessels compared to 7% with MRI in (p < 0.001). The same was true for patients with new-onset disease. US detected vasculitic changes in 22% of vessels and MRI detected disease in 6% (p = 0.0004). Compared to contrast-enhanced MRA, US was more sensitive in detecting vasculitic changes in the large arteries, including the axillary, carotid, and subclavian arteries. Conclusion US more frequently detects vasculitic changes in the large arteries compared to contrast-enhanced MRA. When evaluating the cranial vessels, US performs similarly to MRI. This data supports the recommendation that US be considered as a first-line evaluation in patients suspected to have GCA.
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Affiliation(s)
- Ashley Yip
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Frode Lohne
- Department of Radiology, Hospital of Southern Norway Trust Kristiansand, Kristiansand, Norway
| | | | - Geirmund Myklebust
- Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Kristiansand, Norway
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507
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Zhang Y, Fan P, Zhang H, Ma W, Song L, Wu H, Cai J, Luo F, Zhou X. Clinical characteristics and outcomes of chronic heart failure in adult Takayasu arteritis: A cohort study of 163 patients. Int J Cardiol 2020; 325:103-108. [PMID: 33086124 DOI: 10.1016/j.ijcard.2020.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 09/24/2020] [Accepted: 10/11/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) is a serious complication and a major cause of mortality in patients with Takayasu arteritis (TA). We aimed to explore the clinical features and long-term outcomes in TA patients with CHF. METHODS AND RESULTS Adult TA patients admitted to our hospital between January 2009 to April 2018 were classified as HF and non-HF group. The adverse events were defined as a composite of all-cause mortality and hospitalization for HF. The outcome of the HF-group was further analyzed. A total of 61 HF patients and 102 non-HF patients were identified. In the HF group, the median age at assessment was 41.9 years, and female was predominant (82.0%). The multivariable logistic regression model revealed that pulmonary hypertension, aortic regurgitation, mitral regurgitation, level albumin, and uric acid were independently associated with CHF. After a median follow-up of 1347 days, 25 adverse events occurred in HF patients, and the 5-year event-free rate was 54.7%. The Cox model showed that coronary artery involvement, aortic regurgitation, without interventional treatment were related to adverse events. CONCLUSIONS The 5-year event-free rate was not satisfying. Aggressive intervention may decreased the likelihood of adverse events in patients with CHF.
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Affiliation(s)
- Ying Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Peng Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Huimin Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Wenjun Ma
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lei Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Haiying Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Cai
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Fang Luo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
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508
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Immunosuppression medication and cardiac function improvement treatments might prevent Takayasu arteritis patients with aortitis from receiving cardiac surgery. Chin Med J (Engl) 2020; 134:625-627. [PMID: 33060369 PMCID: PMC7929491 DOI: 10.1097/cm9.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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509
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Abstract
Purpose of Review Guidelines for the management of large vessel vasculitides have been recently updated by several scientific societies. We have evaluated the current recommendations for treatment of giant cell arteritis (GCA) and Takayasu arteritis (TA) and addressed potential future therapeutic strategies. Recent Findings While glucocorticoids (GCs) remain the gold standard for induction of remission, many patients relapse and acquire high cumulative GC exposure. Thus, GC-sparing therapies such as methotrexate are recommended for selected patients with GCA and all patients with TA. Recent high-quality evidence shows that tocilizumab is an effective GC-sparing agent in GCA. Non-biologic and biologic immunomodulators also appear to have GC-sparing properties in TA. Summary Tocilizumab is now considered to be part of the standard treatment for GCA, particularly with relapsing disease, but questions on its use such as length of treatment and monitoring of disease activity remain open. High-quality evidence to guide treatment of TA is still lacking.
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510
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Palmowski A, Buttgereit F. Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis. Curr Rheumatol Rep 2020; 22:85. [PMID: 33047263 PMCID: PMC7550368 DOI: 10.1007/s11926-020-00961-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/14/2022]
Abstract
Purpose While glucocorticoids (GCs) are effective in large vessel vasculitis (LVV), they may cause serious adverse events (AEs), especially if taken for longer durations and at higher doses. Unfortunately, patients suffering from LVV often need long-term treatment with GCs; therefore, toxicity needs to be expected and countered. Recent Findings GCs remain the mainstay of therapy for both giant cell arteritis and Takayasu arteritis. In order to minimize their toxicity, the following strategies should be considered: GC tapering, administration of conventional synthetic (e.g., methotrexate) or biologic (e.g., tocilizumab) GC-sparing agents, as well as monitoring, prophylaxis, and treatment of GC-related AEs. Several drugs are currently under investigation to expand the armamentarium for the treatment of LVV. Summary GC treatment in LVV is effective but associated with toxicity. Strategies to minimize this toxicity should be applied when treating patients suffering from LVV.
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Affiliation(s)
- Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin, Germany.
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511
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Mackie S, Neill L, Byrne D, Mollan S, Dasgupta B, Dejaco C. Comment on: British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis: reply. Rheumatology (Oxford) 2020; 59:e163-e164. [DOI: 10.1093/rheumatology/keaa475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/28/2020] [Accepted: 06/23/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
- Leeds NIHR Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds
| | | | | | - Susan Mollan
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Bhaskar Dasgupta
- Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, UK
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512
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Dammacco F, Cirulli A, Simeone A, Leone P, Pulli R, Angiletta D, Rubini G, Di Palo A, Vacca A, Dammacco R. Takayasu arteritis: a cohort of Italian patients and recent pathogenetic and therapeutic advances. Clin Exp Med 2020; 21:49-62. [PMID: 33026580 PMCID: PMC7867549 DOI: 10.1007/s10238-020-00668-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/28/2020] [Indexed: 04/03/2023]
Abstract
Takayasu arteritis (TAK) is a rare granulomatous vasculitis of unknown etiology that mainly affects the aorta and its major branches. The aim is to describe the clinical features, diagnostic procedures, pathogenesis, and management of TAK in a longitudinal cohort of patients recruited within a single region of southern Italy. The cohort included 43 patients who were diagnosed with TAK and followed up according to a standard protocol, in a collaboration between four university tertiary referral centers and a regional hospital. Clinical and imaging classification criteria were those established by the American College of Rheumatology. Thirty-five patients (81.4%) were female, and the mean age at disease onset was 32.6 (range 16–54) years. Angiographic assessment of the vascular involvement allowed disease classification in five different types. Clinical features ranged from constitutional symptoms in the early inflammatory stage of the disease to cardiovascular ischemic symptoms in the late, chronic stage. Noninvasive imaging techniques were employed to assess the extent and severity of the arterial wall damage and to monitor the clinical course and response to therapy. Medical treatment, based on pathogenetic insights into the roles of humoral and cell-mediated immune mechanisms, included glucocorticoids mostly combined with steroid-sparing immunosuppressive agents and, in patients with relapsing/refractory disease, biologic drugs. Significant clinical and angiographic differences have been detected in TAK patients from different geographic areas. Patients with life-threatening cardiovascular and neurologic manifestations as well as sight-threatening ophthalmologic signs and symptoms should be promptly diagnosed, properly treated, and closely followed up to avoid potentially severe consequences.
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Affiliation(s)
- Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, Medical School, Polyclinic, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Anna Cirulli
- Department of Biomedical Sciences and Human Oncology, Medical School, Polyclinic, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Annalisa Simeone
- Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, Medical School, Polyclinic, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Raffaele Pulli
- Department of Emergency and Organ Transplantation, Vascular and Endovascular Surgery Unit, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - Domenico Angiletta
- Department of Emergency and Organ Transplantation, Vascular and Endovascular Surgery Unit, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Rubini
- Department of Interdisciplinary Medicine, Nuclear Medicine Unit, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - Alessandra Di Palo
- Department of Interdisciplinary Medicine, Nuclear Medicine Unit, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Medical School, Polyclinic, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, Medical School, University of Bari Aldo Moro, Bari, Italy
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513
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Incidence and prevalence of giant cell arteritis and polymyalgia rheumatica: A systematic literature review. Semin Arthritis Rheum 2020; 50:1040-1048. [DOI: 10.1016/j.semarthrit.2020.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/29/2022]
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514
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Mertz P, Kleinmann JF, Lambert M, Puéchal X, Bonnin A, Boulon C, Diot E, Hachulla E, Harid N, Harle JR, Helder G, Kahn JE, Kone-Paut I, Lavigne C, Magy-Bertrand N, Maillard H, Martin T, Maurier F, Poindron V, Schleinitz N, Sibilia J, Arnaud L. Infliximab is an effective glucocorticoid-sparing treatment for Takayasu arteritis: Results of a multicenter open-label prospective study. Autoimmun Rev 2020; 19:102634. [DOI: 10.1016/j.autrev.2020.102634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023]
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515
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Liozon E, Dumonteil S, Parreau S, Gondran G, Bezanahary H, Palat S, Ly KH, Fauchais AL. Risk profiling for a refractory course of giant cell arteritis: The importance of age and body weight: "Risk profiling for GC resistance in GCA". Semin Arthritis Rheum 2020; 50:1252-1261. [PMID: 33065420 DOI: 10.1016/j.semarthrit.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Giant cell arteritis (GCA) is a disease that relapses often, and some patients run a refractory course. Although prompt recognition of resistant GCA is a major issue, there is no well-recognized, baseline risk factor for poor response to glucocorticoid (GC) treatment. METHODS We included all patients consecutively diagnosed with GCA and homogeneously treated since 1976 in a single department and regularly followed-up for at least 18 months. Using a set of customized criteria defining response to GCs, we separated patients into highly responsive, usually responsive, dependent on GCs, and resistant to GCs. We determined which of the baseline variables were associated with GC-resistance and conducted factor analyses of mixed data and decision tree analyses. We also determined whether being GC-resistant was associated with poorer tolerance to GCs and higher death rates. RESULTS In all, 455 patients were followed for 93.4 ± 67.6 (standard deviation) months; 41 (9%) and 21 (4.6%) patients developed GC-dependent and GC-resistant disease, respectively. Factor analyses suggested an association between clinical pattern and degree of responsiveness to GCs; The decision tree analyses, built on an age at GCA onset 〈 66 years and body weight 〉 71 kg, delineated a high risk profile (44% of the patients who featured both characteristics were GC-resistant vs. less than 3% who featured neither, p < 0.001). Infections were more prevalent in the GC-resistant or GC-dependent patients, but without decreasing their survival. CONCLUSION Extra-cranial, large-vessel GCA may be associated with prolonged GC requirements. A simple combination of age and body weight defined a subgroup of patients at high risk for developing GC resistance. Our findings need confirmation in prospective controlled studies.
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Affiliation(s)
- Eric Liozon
- Departments of 1Internal Medicine, University Hospital of Limoges, France.
| | - Stéphanie Dumonteil
- Departments of 1Internal Medicine, University Hospital of Limoges, France; Functional Unit of Clinical Research and Biostatistics, Limoges School of Medicine, Limoges Cedex, France
| | - Simon Parreau
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Guillaume Gondran
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Holy Bezanahary
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Sylvain Palat
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Kim-Heang Ly
- Departments of 1Internal Medicine, University Hospital of Limoges, France
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516
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Watanabe R, Berry GJ, Liang DH, Goronzy JJ, Weyand CM. Cellular Signaling Pathways in Medium and Large Vessel Vasculitis. Front Immunol 2020; 11:587089. [PMID: 33072134 PMCID: PMC7544845 DOI: 10.3389/fimmu.2020.587089] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022] Open
Abstract
Autoimmune and autoinflammatory diseases of the medium and large arteries, including the aorta, cause life-threatening complications due to vessel wall destruction but also by wall remodeling, such as the formation of wall-penetrating microvessels and lumen-stenosing neointima. The two most frequent large vessel vasculitides, giant cell arteritis (GCA) and Takayasu arteritis (TAK), are HLA-associated diseases, strongly suggestive for a critical role of T cells and antigen recognition in disease pathogenesis. Recent studies have revealed a growing spectrum of effector functions through which T cells participate in the immunopathology of GCA and TAK; causing the disease-specific patterning of pathology and clinical outcome. Core pathogenic features of disease-relevant T cells rely on the interaction with endothelial cells, dendritic cells and macrophages and lead to vessel wall invasion, formation of tissue-damaging granulomatous infiltrates and induction of the name-giving multinucleated giant cells. Besides antigen, pathogenic T cells encounter danger signals in their immediate microenvironment that they translate into disease-relevant effector functions. Decisive signaling pathways, such as the AKT pathway, the NOTCH pathway, and the JAK/STAT pathway modify antigen-induced T cell activation and emerge as promising therapeutic targets to halt disease progression and, eventually, reset the immune system to reestablish the immune privilege of the arterial wall.
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Affiliation(s)
- Ryu Watanabe
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Gerald J Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - David H Liang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Jörg J Goronzy
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Cornelia M Weyand
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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517
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Sené T, Arej N, Lecler A, Dupont C, Vasseur V, Mauget-Faÿsse M, Vignal-Clermont C. Visual Recovery with Iloprost Added to Corticosteroids in a Case of Giant Cell Arteritis. Ocul Immunol Inflamm 2020; 30:497-499. [PMID: 32976035 DOI: 10.1080/09273948.2020.1802489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION To date, corticosteroids remain the cornerstone treatment of ocular involvement of GCA, and no other treatment has proven to be effective in this setting. We herein report on a unique case of GCA with ocular involvement worsening despite high dose corticosteroids and recovering with intravenous iloprost. CASE REPORT A 70-year-old man presented with acute vision loss in his left eye related to anterior ischemic optic neuropathy. The diagnosis of giant-cell arteritis was confirmed by a temporal artery biopsy. Despite intravenous pulse methylprednisolone for 3 days then oral prednisone at 60 mg/day, the patient developed from day 5 fluctuating vision loss in the right eye, related to ocular ischemia by occlusion of the ophthalmic artery, and responsive to hyperhydration. Iloprost, an analog of prostacyclin PGI2, was then administered intravenously for 5 days and resulted in a stable improvement in visual acuity in the right eye. CONCLUSION This case highlights the potential role of vasodilatator agents in giant cell arteritis with ocular involvement.
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Affiliation(s)
- Thomas Sené
- Department of Internal Medicine, Rothschild Foundation Hospital, Paris, France
| | - Nicolas Arej
- Department of Ophthalmology (Vitreoretinal Division), Rothschild Foundation Hospital, Paris, France.,Department of Clinical Research, Rothschild Foundation Hospital, Paris, France
| | - Augustin Lecler
- Department of Medical Imaging, Rothschild Foundation Hospital, Paris, France
| | - Chloé Dupont
- Department of Pharmacology, Rothschild Foundation Hospital, Paris, France
| | - Vivien Vasseur
- Department of Clinical Research, Rothschild Foundation Hospital, Paris, France
| | | | - Catherine Vignal-Clermont
- Department of Ophthalmology (Neuro-ophthalmology Section), Rothschild Foundation Hospital, Paris, France
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518
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Pazzola G, Pipitone N, Salvarani C. Cardiac involvement in the adult primary vasculitides. Expert Rev Clin Immunol 2020; 16:985-991. [PMID: 32954889 DOI: 10.1080/1744666x.2021.1823219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Heart involvement in vasculitis is rare, but potentially severe. The ascertainment of cardiac disease in vasculitis is complex and requires an integrated multidisciplinary approach involving the Rheumatologist, Radiologist, Cardiologist, and Heart surgeon. AREAS COVERED the authors searched PubMed using the keywords 'heart'[Mesh] and vasculitis"[Mesh]. EXPERT OPINION Virtually any vasculitis can affect the heart, but cardiac involvement is more common in some vasculitides such as Takayasu arteritis, polyarteritis nodosa, and eosinophilic granulomatosis with polyangiitis. Immunosuppressive treatment and when indicated surgery can improve the prognosis.
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Affiliation(s)
- Giulia Pazzola
- Rheumatology Unit, Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia , Reggio Emilia, Italy
| | - Nicolò Pipitone
- Rheumatology Unit, Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia , Reggio Emilia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia , Reggio Emilia, Italy
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519
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Wipfler-Freißmuth E, Dejaco C, Both M. [Long-term complications, monitoring and interventional treatment of large vessel vasculitis]. Z Rheumatol 2020; 79:523-531. [PMID: 32430565 DOI: 10.1007/s00393-020-00807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) both belong to the group of large vessel vasculitides and require long-term drug treatment. Glucocorticoids (GC) are the first choice for the treatment of both diseases. For GCA immunosuppressants, such as tocilizumab or methotrexate should be considered in cases of treatment refractory and relapses or if there is a high risk for GC-related adverse events. In TAK patients the use of immunosuppressive agents should be considered for all patients. In the course of the disease, severe disease-associated and treatment-associated complications can occur. The most frequent disease-associated complications include visual impairment up to blindness in GCA, as well as vascular stenoses with ischemia and aortic aneurysms with possible dissection in GCA and TAK. Percutaneous transluminal angioplasty (PTA) and stenting are minimally invasive, low-risk interventional procedures for GCA and TAK patients with clinically significant vascular stenoses, despite a tendency to restenosis. Interventional procedures should be weighed up against vascular surgical approaches depending on the localization and the total clinical situation. All interventions should be conducted in a phase of stable remission when possible. For monitoring of disease activity in patients with GCA and TAK, assessment of clinical manifestations as well as C‑reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) are useful; however, both are unreliable under interleukin‑6 block with tocilizumab. The value of new biomarkers independent from interleukin‑6 and the importance of imaging (sonography, magnetic resonance angiography, computed tomography and positron emission tomography-CT) for monitoring GCA and TAK still have to be investigated in future studies.
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Affiliation(s)
- E Wipfler-Freißmuth
- Rheumatologische Spezialambulanz, Krankenhaus der Barmherzigen Brüder Graz-Eggenberg, Bergstr. 27, 8010, Graz, Österreich.
| | - C Dejaco
- Landesweiter Dienst für Rheumatologie, Südtiroler Sanitätsbetrieb, Krankenhaus Bruneck, Bruneck, Italien
| | - M Both
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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520
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Nakaoka Y, Yamashita K, Yamakido S. Comment on: Long-term efficacy and safety of tocilizumab in refractory Takayasu arteritis: final results of the randomized controlled phase 3 TAKT study: reply. Rheumatology (Oxford) 2020; 59:e48-e49. [PMID: 32594147 PMCID: PMC7449802 DOI: 10.1093/rheumatology/keaa255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita
| | - Katsuhisa Yamashita
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka
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521
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Sebastian A, Tomelleri A, Kayani A, Prieto-Pena D, Ranasinghe C, Dasgupta B. Probability-based algorithm using ultrasound and additional tests for suspected GCA in a fast-track clinic. RMD Open 2020; 6:e001297. [PMID: 32994361 PMCID: PMC7547539 DOI: 10.1136/rmdopen-2020-001297] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/22/2020] [Accepted: 09/05/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Clinical presentations of giant cell arteritis (GCA) are protean, and it is vital to make a secure diagnosis and exclude mimics for urgent referrals with suspected GCA. The main objective was to develop a joined-up, end-to-end, fast-track confirmatory/exclusionary, algorithmic process based on a probability score triage to drive subsequent investigations with ultrasound (US) and any appropriate additional tests as required. METHODS The algorithm was initiated by stratifying patients to low-risk category (LRC), intermediate-risk category (IRC) and high-risk category (HRC). Retrospective data was extracted from case records. The Southend pretest probability score (PTPS) overall showed a median score of 9 and a 75th percentile score of 12. We, therefore, classified LRC as PTPS <9, IRC 9-12 and HRC >12. GCA diagnosis was made by a combination of clinical, US, and laboratory findings. The algorithm was assessed in all referrals seen in 2018-2019 to test the diagnostic performance of US overall and in individual categories. RESULTS Of 354 referrals, 89 had GCA with cases categorised as LRC (151), IRC (137) and HRC (66). 250 had US, whereas 104 did not (score <7, and/or high probability of alternative diagnoses). In HRC, US showed sensitivity 94%, specificity 85%, accuracy 92% and GCA prevalence 80%. In LRC, US showed sensitivity undefined (0/0), specificity 98%, accuracy 98% and GCA prevalence 0%. In IRC, US showed sensitivity 100%, specificity 97%, accuracy 98% and GCA prevalence 26%. In the total population, US showed sensitivity 97%, specificity 97% and accuracy 97%. Prevalence of GCA overall was 25%. CONCLUSIONS The Southend PTPS successfully stratifies fast-track clinic referrals and excludes mimics. The algorithm interprets US in context, clarifies a diagnostic approach and identifies uncertainty, need for re-evaluation and alternative tests. Test performance of US is significantly enhanced with PTPS.
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Affiliation(s)
- Alwin Sebastian
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
| | - Alessandro Tomelleri
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Abdul Kayani
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
| | - Diana Prieto-Pena
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
- Rheumatology, Marques de Valdecilla University Hospital, Santander, Spain
| | - Chavini Ranasinghe
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
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522
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Abstract
Purpose of Review To review the spectrum of vasculitides in HIV-infected patients and to identify the clinical features that characterize vasculitis in sero-positive HIV. Recent Findings Epidemiological studies conducted in the post-HAART era described the rarity of vasculitis in the setting of HIV-infected patients. A study identified histopathological features such as leukocytoclastic vasculitis of the vasa vasorum and adventitial inflammation in the large artery pathology of HIV-positive patients compared with HIV-negative patients with critical lower limb ischemia. A recent retrospective cohort study reported that HIV-positive patients with LVV developed more vascular complications, responded less to antiretroviral therapy, and had worse outcome than HIV-negative patients with LVV. Summary Vasculitides continue to be a rare disease in patients with HIV. The spectrum of vasculitis ranges from life-threatening conditions to relatively mild skin conditions. Recognizing vasculitis in the setting of HIV-positive patients is important because sometimes it require immunosuppressive treatment.
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Affiliation(s)
- Luis E Vega
- Section of Rheumatology, Air Force Central Hospital, Aramburú Ave 2nd block, Lima, Peru.
| | - Luis R Espinoza
- Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA, 70112, USA
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523
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A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Parallel-Group Study to Evaluate the Efficacy and Safety of Sirukumab in the Treatment of Giant Cell Arteritis. Rheumatol Ther 2020; 7:793-810. [PMID: 32844378 PMCID: PMC7695797 DOI: 10.1007/s40744-020-00227-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION To evaluate the efficacy and safety of sirukumab in giant cell arteritis (GCA). METHODS In this multicentre, randomised, double-blind, placebo-controlled, two-part phase 3 trial (NCT02531633; Part A [52-week double-blind treatment]; Part B [104-week follow-up]), patients with GCA were randomised (3:3:2:2:2) to sirukumab 100 mg every 2 weeks plus 6-month or 3-month prednisone taper, sirukumab 50 mg every 4 weeks plus 6-month prednisone taper, or placebo every 2 weeks plus 6-month or 12-month prednisone taper. The primary endpoint was the proportion of patients in sustained remission at week 52. Secondary endpoints included disease flare and safety. The study was terminated early (October 2017; sponsor decision). RESULTS Of 161 patients randomised (sirukumab: n = 107; placebo: n = 54), 28 (17.4%) completed week 52 (median treatment duration: 24-30 weeks). In a revised intent-to-treat (ITT) subgroup (completed week 52 or discontinued before study termination [n = 55]); six patients (all receiving sirukumab) achieved the primary endpoint. In the ITT population (n = 161), the proportion of patients with flares (week 2-52) was lower with sirukumab (18.4-30.8%) than placebo (37.0-40.0%). The proportion of patients with flares (week 2-12) was highest with sirukumab 100 mg every 2 weeks plus 3-month prednisone taper (23.1%). In Part A, 94.4% of patients reported ≥ 1 treatment-emergent adverse event (TEAE); 19.3% reported serious TEAEs. The proportions of patients with TEAEs were generally similar across treatment arms. No deaths occurred. CONCLUSIONS Although data were limited due to early termination and shortened treatment duration, sirukumab treatment resulted in numerically lower proportions of patients with flare by week 52 versus placebo, with no unexpected safety findings. TRIAL REGISTRATION Clinicaltrials.gov: NCT02531633.
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524
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Claeys E, Gheysens O, Meersseman W, Verbeken E, Blockmans D, Henckaerts L. Facial nerve palsy in giant-cell arteritis: case-based review. Rheumatol Int 2020; 41:481-486. [PMID: 32794114 DOI: 10.1007/s00296-020-04673-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/02/2020] [Indexed: 12/20/2022]
Abstract
Acute peripheral facial nerve palsy is most frequently idiopathic (Bell's palsy) or virally induced, but can also be due to several other conditions. A rare cause is underlying systemic or autoimmune disease. A 79-year-old man presented with peripheral facial nerve palsy, malaise, and fever. Physical examination revealed tenderness of the left temporal artery and reduced pulsatility. 18F-FDG-PET/CT and biopsy of the temporal artery confirmed the diagnosis of giant cell arteritis (GCA). Prompt institution of corticosteroid therapy produced rapid decrease in inflammatory markers and gradual improvement of the facial nerve palsy. We searched the MEDLINE, Embase, and Scopus databases to identify previous reports of peripheral nerve palsy in GCA, other vasculitides, and autoimmune diseases. Facial nerve palsy as the presenting symptom of GCA has very rarely been reported. Although temporal artery biopsy is the gold standard for diagnosis, it may be negative in up to one-third of cases. In doubtful cases, imaging can help establish the diagnosis. Ultrasound, 3 T MRI, and 18F-FDG-PET/CT have all been previously reported to be useful. Peripheral facial nerve palsy may very rarely be the presenting symptom of GCA. Early correct diagnosis is essential for starting appropriate therapy. In patients with atypical features, 18F-FDG-PET/CT may be useful for establishing the diagnosis.
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Affiliation(s)
- Eveline Claeys
- Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium.
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Wouter Meersseman
- Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Eric Verbeken
- Department of Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Daniel Blockmans
- Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Liesbet Henckaerts
- Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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525
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Ćorović A, Wall C, Mason JC, Rudd JHF, Tarkin JM. Novel Positron Emission Tomography Tracers for Imaging Vascular Inflammation. Curr Cardiol Rep 2020; 22:119. [PMID: 32772188 PMCID: PMC7415747 DOI: 10.1007/s11886-020-01372-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of Review To provide a focused update on recent advances in positron emission tomography (PET) imaging in vascular inflammatory diseases and consider future directions in the field. Recent Findings While PET imaging with 18F-fluorodeoxyglucose (FDG) can provide a useful marker of disease activity in several vascular inflammatory diseases, including atherosclerosis and large-vessel vasculitis, this tracer lacks inflammatory cell specificity and is not a practical solution for imaging the coronary vasculature because of avid background myocardial signal. To overcome these limitations, research is ongoing to identify novel PET tracers that can more accurately track individual components of vascular immune responses. Use of these novel PET tracers could lead to a better understanding of underlying disease mechanisms and help inform the identification and stratification of patients for newly emerging immune-modulatory therapies. Summary Future research is needed to realise the true clinical translational value of PET imaging in vascular inflammatory diseases.
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Affiliation(s)
- Andrej Ćorović
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Christopher Wall
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Justin C Mason
- Cardiovascular Division, National Heart & Lung Institute, Imperial College London, London, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK. .,Cardiovascular Division, National Heart & Lung Institute, Imperial College London, London, UK.
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526
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Lecler A, Villeneuve D, Vignal C, Sené T. Increased rather than decreased incidence of giant-cell arteritis during the
COVID-19 pandemic. Ann Rheum Dis 2020; 80:e89. [DOI: 10.1136/annrheumdis-2020-218343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/04/2022]
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527
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Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica. Nat Rev Rheumatol 2020; 16:481-495. [DOI: 10.1038/s41584-020-0458-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 02/08/2023]
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528
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Mukhtyar C, Myers H, Jones C, Dhatariya K. The relationship between glycated haemoglobin levels and the risk of giant cell arteritis - a case-control study. Rheumatol Adv Pract 2020; 4:rkaa018. [PMID: 32734138 PMCID: PMC7380559 DOI: 10.1093/rap/rkaa018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives The EULAR core dataset for observational studies in GCA does not include glycated haemoglobin (HbA1c). A multivariable score to stratify the pre-test probability of GCA also does not include HbA1c. There have been contradictory reports about diabetes mellitus being a risk factor for GCA. We report the first study analysing the relationship of pre-diagnosis HbA1c with the risk of GCA. Methods This was a single-centre retrospective case–control study conducted in Norfolk, UK. All GCA cases were diagnosed with imaging or biopsy. Each case was assigned two age- and sex-matched controls. The primary outcome measure was the glycaemic status (HbA1c categorized into euglycaemia, pre-diabetes or diabetes mellitus) at diagnosis between cases and controls. The HbA1c was compared between two groups using the Mann–Whitney U test. The glycaemic categorization was compared using the χ2 test. Results One hundred and twelve cases and 224 controls were included. The median (interquartile range) of HbA1c of cases and controls was 40 (37, 43) and 41 (39, 47) mmol/mol (P < 0.001), respectively. Ten of 112 cases and 52 of 224 controls had diabetes mellitus. The χ2 test demonstrated a significant interaction between glycaemic state and GCA (P = 0.006). Individuals with diabetes mellitus had an odds ratio (95% CI) of 0.32 (0.13, 0.74) (P = 0.008) of having GCA compared with euglycaemic individuals. Conclusion HbA1c in the diabetic range reduces the probability of GCA. HbA1c should be considered in any multivariable score to calculate the risk of GCA, and in future development of diagnostic and classification criteria. There is a need for an epidemiological study looking at the possibility of a protective nature of diabetes mellitus against GCA or whether it is only a mimic.
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Affiliation(s)
- Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust.,Norwich Medical School, University of East Anglia
| | - Holly Myers
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust.,Norwich Medical School, University of East Anglia
| | - Colin Jones
- Department of Ophthalmology, Norfolk and Norwich University Hospital NHS Foundation Trust
| | - Ketan Dhatariya
- Norwich Medical School, University of East Anglia.,Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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529
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Großgefäßvaskulitiden. Z Rheumatol 2020; 79:503-504. [DOI: 10.1007/s00393-020-00810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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530
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Fan L, Yang L, Wei D, Ma W, Lou Y, Song L, Bian J, Zhang H, Cai J. Clinical Scenario and Long-Term Outcome of Childhood Takayasu Arteritis Undergoing 121 Endovascular Interventions: A Large Cohort Over a Fifteen-Year Period. Arthritis Care Res (Hoboken) 2020; 73:1678-1688. [PMID: 32702156 DOI: 10.1002/acr.24387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Evidence-based studies on endovascular approaches for childhood Takayasu arteritis (TAK) are limited. Our objective was to present the largest current real-world scenario for patients with childhood TAK undergoing interventions and their postinterventional outcomes. METHODS Data were collected for patients with childhood TAK admitted from 2002 to 2017. Complication/reintervention-free survival was projected by Kaplan-Meier methods. Associated factors for intervention and predictors for postinterventional complications/reinterventions were assessed via regression models. RESULTS Among 101 patients enrolled, 69 (68.3%) underwent 121 interventions (angioplasty 95, stenting 26) during a 3.1-year follow-up. Compared with the nonintervention group, the intervention group independently associated with a male population (odds ratio [OR] 0.27, P = 0.035) and type IV disease (OR 17.92, P = 0.001). Male sex also marginally indicated a risk for reintervention (hazard ratio [HR] 3.22, P = 0.05). Baseline retinopathy, delay in diagnosis, and descending thoracic aorta involvement were associated with stent insertion (P < 0.05). Hypertension secondary to renal artery stenosis (RAS; 59.4%) or mid-aorta stenosis (MAS; 14.5%), heart failure (21.7%), and claudication (21.7%) were leading clinical hints for interventions. The technical success rate was 96.7%. During a median 2.88-year of follow-up after intervention, 36 lesions occurred with complications in 28 patients, and 22 lesions in 17 patients, particularly on the renal artery or mid-aorta. The 5-year complication-free and reintervention-free survivals were 50.7% and 65.8%, respectively. Peri-interventional dual antiplatelet therapy (DAPT; HR 0.31), concurrent surgery (HR 26.5), and technical failure (HR 3.65) were independent predictors for complications (P < 0.05). Male sex (HR 2.52), retinopathy secondary to hypertension (HR 3.41), and pulmonary artery hypertension (PAH; HR 3.64) were baseline indicators for complications (P < 0.05). CONCLUSION Over two-thirds of patients with childhood TAK require interventions, and the 5-year complication-free survival is 50.7%. Male sex, retinopathy, and PAH at baseline indicate the possibility of unfavorable outcomes. Interventions on MAS or RAS in childhood TAK raise specific concerns. DAPT peri-intervention appears to protect patients with childhood TAK from postinterventional complications.
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Affiliation(s)
- Luyun Fan
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lirui Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongmei Wei
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjun Ma
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Lou
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Song
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Bian
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huimin Zhang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Cai
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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531
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Sené T, Clavel G, Villeneuve D, Philibert M, Mauget-Faÿsse M, Lamirel C, Lecler A, Gout O, Hage R, Lidove O, Vignal-Clermont C. [Delays in the management of ocular complications of giant cell arteritis: A retrospective monocentric study of 33 patients]. Rev Med Interne 2020; 41:661-666. [PMID: 32682624 DOI: 10.1016/j.revmed.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/05/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ocular complications of giant cell arteritis (GCA) can lead to irreversible bilateral blindness and represent a therapeutic emergency. Recommendations for the management of GCA have recently been updated. The objective of the study was to evaluate delays in appropriate management of the ocular complications of GCA and its determinants. METHOD Retrospective, monocentric study, conducted over the period January 2013-November 2018. All consecutive patients with a final diagnosis of GCA and related visual impairment (permanent visual loss and/or alteration of visual field) were included. RESULTS Thirty-three patients were included (women: 21, men: 12; mean age at diagnosis: 79). Twenty-seven patients (82%) presented with symptoms suggestive of ACG prior to the visual complication, ranging from a few weeks to several months. Seventeen patients (52%) had a known biological inflammatory syndrome (median CRP at 64 mg/L) prior to hospital consultation. The median time from the onset of permanent ophthalmologic manifestations to appropriate corticosteroid management was 3 days (range: 0-134). Two of the 21 patients who consulted an out-of-hospital ophthalmologist received corticosteroid therapy before referral to hospital. Three patients (9%) were treated within 24 h of the onset of the disorders. CONCLUSION There is a significant delay in the appropriate management of ophthalmological complications of ACG and deviations from current recommendations. Numerous actions must therefore be taken to improve the visual prognosis of patients with ACG, both preventively (i.e. early diagnosis and treatment of ACG before the possible occurrence of visual complications), and curatively (rapid recognition and immediate treatment of ocular complications). These elements support the relevance of specific fast-track pathways for GCA.
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Affiliation(s)
- T Sené
- Service de Médecine Interne, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France; Service de Médecine Interne, Hôpital de la Croix Saint-Simon - Groupe Hospitalier Diaconesses-Croix Saint-Simon, 75020 Paris, France.
| | - G Clavel
- Service de Médecine Interne, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - D Villeneuve
- Service de Médecine Interne, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - M Philibert
- Service de Neuro-Ophtalmologie, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - M Mauget-Faÿsse
- Centre d'Investigations Cliniques, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - C Lamirel
- Service d'Ophtalmologie, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - A Lecler
- Service d'Imagerie, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - O Gout
- Service de Neurologie, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - R Hage
- Service de Neuro-Ophtalmologie, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - O Lidove
- Service de Médecine Interne, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France; Service de Médecine Interne, Hôpital de la Croix Saint-Simon - Groupe Hospitalier Diaconesses-Croix Saint-Simon, 75020 Paris, France
| | - C Vignal-Clermont
- Service de Neuro-Ophtalmologie, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France; Service des Urgences Ophtalmologiques, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
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532
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Fujiwara Y, Yamaguchi T, Nakane M. Granulocyte Colony-Stimulating Factor-Associated Aortitis: Treatment Suggestion for This Complication. JCO Oncol Pract 2020; 17:57-58. [PMID: 32644903 DOI: 10.1200/op.20.00121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yu Fujiwara
- Department of Medical Oncology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Takeshi Yamaguchi
- Department of Medical Oncology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Minoru Nakane
- Department of Medical Oncology, Musashino Red Cross Hospital, Tokyo, Japan
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533
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Borodina IE, Sablin IV, Popov AA, Ageev AN. [Takayusu Arteritis on the background of congenital vascular anomaly?]. KARDIOLOGIIA 2020; 60:688. [PMID: 32720626 DOI: 10.18087/cardio.2020.6.n688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/14/2019] [Indexed: 06/11/2023]
Abstract
The article described a female patient with high-grade arterial hypertension diagnosed at her young age. Congenital abdominal aortic hyperplasia and conformity with criteria for Takayasu arteritis were diagnosed at 10 years following the clinical manifestation.
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Affiliation(s)
- I E Borodina
- Urals State Medical University, Yekaterinburg, Russia Urals State Regional clinical hospital # 1, Yekaterinburg, Russia
| | - I V Sablin
- Urals State Regional clinical hospital # 1, Yekaterinburg, Russia
| | - A A Popov
- Urals State Medical University, Yekaterinburg, Russia
| | - A N Ageev
- Urals State Medical University, Yekaterinburg, Russia Urals State Regional clinical hospital # 1, Yekaterinburg, Russia
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534
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Perricone C, Triggianese P, Bartoloni E, Cafaro G, Bonifacio AF, Bursi R, Perricone R, Gerli R. The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19. J Autoimmun 2020; 111:102468. [PMID: 32317220 PMCID: PMC7164894 DOI: 10.1016/j.jaut.2020.102468] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has posed the world at a pandemic risk. Coronavirus-19 disease (COVID-19) is an infectious disease caused by SARS-CoV-2, which causes pneumonia, requires intensive care unit hospitalization in about 10% of cases and can lead to a fatal outcome. Several efforts are currently made to find a treatment for COVID-19 patients. So far, several anti-viral and immunosuppressive or immunomodulating drugs have demonstrated some efficacy on COVID-19 both in vitro and in animal models as well as in cases series. In COVID-19 patients a pro-inflammatory status with high levels of interleukin (IL)-1B, IL-1 receptor (R)A and tumor necrosis factor (TNF)-α has been demonstrated. Moreover, high levels of IL-6 and TNF-α have been observed in patients requiring intensive-care-unit hospitalization. This provided rationale for the use of anti-rheumatic drugs as potential treatments for this severe viral infection. Other agents, such as hydroxychloroquine and chloroquine might have a direct anti-viral effect. The anti-viral aspect of immunosuppressants towards a variety of viruses has been known since long time and it is herein discussed in the view of searching for a potential treatment for SARS-CoV-2 infection.
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Affiliation(s)
- Carlo Perricone
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Elena Bartoloni
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Angelo F Bonifacio
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Bursi
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Roberto Gerli
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy.
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535
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Stamatis P. Giant Cell Arteritis versus Takayasu Arteritis: An Update. Mediterr J Rheumatol 2020; 31:174-182. [PMID: 32676554 PMCID: PMC7362112 DOI: 10.31138/mjr.31.2.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/24/2020] [Accepted: 03/03/2020] [Indexed: 12/31/2022] Open
Abstract
Giant cell arteritis (GCA) and Takayasu Arteritis (TAK) are two systemic granulomatous vasculitides affecting medium- and large-sized arteries. Similarities in GCA and TAK regarding the clinical presentation, the systemic inflammatory response and the distribution of the arterial lesions, have triggered a debate over the last decade about whether GCA and TAK represent two different diseases, or are age-associated different clinical phenotypes of the same disease. On the other hand, there are differences regarding epidemiology, several clinical features (eg, polymyalgia rheumatica in GCA) and treatment. The aim of this review is to present the latest data regarding this question and to shed some light on the differences and similarities between GCA and TAK regarding epidemiology, genetics, pathogenesis, histopathology, clinical presentation, imaging and treatment. The existing data in literature support the opinion that GCA and TAK are different clinical entities.
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Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences, Rheumatology, Lund University, Sweden
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536
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A giant deception: jaw pain and headache following routine dental extraction. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e81-e88. [PMID: 32565403 DOI: 10.1016/j.oooo.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/18/2020] [Accepted: 05/13/2020] [Indexed: 11/21/2022]
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537
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Performance of the PET vascular activity score (PETVAS) for qualitative and quantitative assessment of inflammatory activity in Takayasu’s arteritis patients. Eur J Nucl Med Mol Imaging 2020; 47:3107-3117. [DOI: 10.1007/s00259-020-04871-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022]
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538
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Karabayas M, Dospinescu P, Locherty M, Moulindu P, Sobti M, Hollick R, De Bari C, Robinson S, Olson J, Basu N. Stratified glucocorticoid monotherapy is safe and effective for most cases of giant cell arteritis. Rheumatol Adv Pract 2020; 4:rkaa024. [PMID: 32914048 PMCID: PMC7474854 DOI: 10.1093/rap/rkaa024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/27/2020] [Indexed: 02/02/2023] Open
Abstract
Objectives High-dose glucocorticoids anchor standard care in GCA but are associated with significant toxicity. We aimed to evaluate the safety and effectiveness of a stratified approach to glucocorticoid tapering. The strategy aggressively reduced glucocorticoid doses in those manifesting an adequate early response to treatment, with a view to minimizing glucocorticoid complications. Methods A retrospective, population-based study of GCA was performed. All cases were confirmed by temporal artery biopsy between November 2010 and November 2015. Baseline and outcome data were extracted from secondary and primary care records at diagnosis and 1 year follow-up. The primary outcome was loss of vision. Secondary outcomes included remission and relapse rates and CS-related complications. Results The cohort consisted of 73 patients (76% female; mean age 73.5 years, s.d. 7.6 years). At presentation, a reduction in visual acuity was recorded in 17 patients (22.3%). The median CRP at diagnosis was 69.5 mg/l [interquartile range (IQR) 40.5–101 mg/l], with a median ESR of 80 mm/h (IQR 60–91 mm/h). At 1 year, remission was achieved in 64 patients (87.7%), whereas 10 patients (13.7%) relapsed. A single patient sustained visual loss after initiation of therapy. The median CRP at 1 year was 4 mg/l (IQR 4–9.5 mg/l) and the mean prednisolone dose was 5.4 mg (0–15 mg). CS-related complications were observed in 10 patients (13.7%). Conclusion A stratified approach to CS tapering appeared safe and effective in GCA. It was associated with a high rate of remission and promisingly low rates of relapse at 1 year follow-up. These real-world data indicate that glucocorticoid exposure can be minimized safely in some patients with GCA.
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Affiliation(s)
- Maira Karabayas
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.,Department of Rheumatology
| | | | | | | | | | - Rosemary Hollick
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.,Department of Rheumatology
| | - Cosimo De Bari
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.,Department of Rheumatology
| | | | | | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
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539
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Fernández-Codina A, Orozco-Gálvez O, Martínez-Valle F. Therapeutic Options in IgG4-Related Disease. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00147-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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540
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Ying S, Xiaomeng C, Xiaomin D, Jiang L, Peng L, Lili M, Rongyi C, Zongfei J, Huiyong C, Lindi J. Efficacy and safety of leflunomide versus cyclophosphamide for initial-onset Takayasu arteritis: a prospective cohort study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20930114. [PMID: 32536986 PMCID: PMC7268110 DOI: 10.1177/1759720x20930114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/07/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Leflunomide (LEF) has been considered as an alternative treatment for Takayasu arteritis (TA); however, data on its efficacy are still scanty. OBJECTIVE To investigate the efficacy and safety of LEF versus cyclophosphamide (CYC) for initial-onset TA. METHODS Initial-onset TA patients with active disease were enrolled in this research. Patients enrolled from 1 January 2009 to 31 December 2015 were treated with glucocorticoids and CYC, while patients enrolled from 1 January 2016 to 31 October 2018 received glucocorticoids and LEF. Treatment response including complete remission (CR), partial remission (PR), and effectiveness rate (ER) and side effects were evaluated at 6 and 12 months. RESULTS AND CONCLUSION In total, 92 patients were enrolled. A total of 47 patients were treated with LEF, while 45 patients were treated with CYC. The CR and ER rates were 75.55%, and 88.89% at 6 months, and 85.37% and 95.12% at 12 months in the LEF group. The CR and ER rates were 39.02% and 70.73% at 6 months, and 56.41% and 82.05% at 12 months in the CYC group. The CR rate was significantly higher in the LEF group than in the CYC group both at 6 months (75.61% versus 38.24%, p < 0.01) and 12 months (77.42% versus 53.33%, p < 0.05) after adjustment for propensity scores. The incidence of side effects in the LEF group was much lower than that in the CYC group (21.28% versus 44.44%). In conclusion, LEF provided a better treatment response, along with lower reproductive toxicity, compared with CYC in initial-onset TA.
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Affiliation(s)
- Sun Ying
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Cui Xiaomeng
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Dai Xiaomin
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Lin Jiang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Lv Peng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Ma Lili
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Chen Rongyi
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Ji Zongfei
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Chen Huiyong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Jiang Lindi
- Department of Rheumatology, Zhongshan Hospital, Fudan University, No 180 Fenglin Road Shanghai, 200032, P. R. China Centre of Evidence-based Medicine, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
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541
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Vela Casasempere P, Ruiz Torregrosa P, García Sevila R. Pneumocystis jirovecii in immunocompromised patients with rheumatic diseases. ACTA ACUST UNITED AC 2020; 17:290-296. [PMID: 32466869 DOI: 10.1016/j.reuma.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/30/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022]
Abstract
Infections, including opportunistic infections, are a major and frequent cause of morbidity and mortality in patients with systemic autoimmune and rheumatic diseases. Pneumocystis jirovecii pneumonia, classically considered to be typical of HIV patients, transplanted patients or patients treated with oncological chemotherapy, is appearing increasingly frequently in these patients. Therefore, rheumatologists should know its mechanism of production, clinical manifestations, treatment and prophylaxis, all of which are addressed in this review.
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Affiliation(s)
- Paloma Vela Casasempere
- Sección de Reumatología. Hospital General Universitario de Alicante. ISABIAL, Alicante, España; Universidad Miguel Hernández, Alicante, España.
| | | | - Raquel García Sevila
- Servicio de Neumología. Hospital General Universitario de Alicante, Alicante, España
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542
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[Treatment of Takayasu arteritis]. Z Rheumatol 2020; 79:532-544. [PMID: 32430564 DOI: 10.1007/s00393-020-00806-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite advances in the diagnosis and treatment, the mortality rate of Takayasu arteritis (TAK) is still elevated even today. The diagnosis is often made after a long time delay and the course of the disease is characterized by progressive structural vascular lesions. Recently, new recommendations for the management of large vessel vasculitis were published by the European League Against Rheumatism (EULAR). For induction of remission oral glucocorticoids (GC) are administered in an initial daily dose of 40-60 mg. As experience has shown that the cumulative GC demand in TAK is high, GC-sparing treatment with moderately potent immunosuppressants, such as methotrexate, azathioprine and mycophenolate mofetil is recommended from the time of initial diagnosis. In cases of a relapsing course, tocilizumab or tumor necrosis factor (TNF)-alpha inhibitors can be used as an additive off-label treatment. If vascular stenoses persist despite supposedly sufficient inflammation control and if these stenoses are symptomatic, vascular surgery or interventional treatment procedures can be indicated. Such revascularization or even surgical procedures for the treatment of aneurysms should be performed during phases of sufficient drug control of the vasculitis. In quite a few patients progressive vascular lesions continue to develop despite clinical and laboratory analytical remission. Due to the poor correlation of clinical symptoms and acute phase markers with the progression of vascular lesions, the distinction between active and inactive diseases is often a challenge in the clinical practice. Imaging studies can then support therapeutic decisions but are not yet formally and comprehensively validated in the long-term course of TAK.
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543
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Numano type V Takayasu arteritis patients are more prone to have coronary artery involvement. Clin Rheumatol 2020; 39:3439-3447. [DOI: 10.1007/s10067-020-05123-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
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544
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Regola F, Cerudelli E, Bosio G, Andreoli L, Tincani A, Franceschini F, Toniati P. Long-term treatment with tocilizumab in giant cell arteritis: efficacy and safety in a monocentric cohort of patients. Rheumatol Adv Pract 2020; 4:rkaa017. [PMID: 32685912 PMCID: PMC7359771 DOI: 10.1093/rap/rkaa017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/04/2020] [Indexed: 01/06/2023] Open
Abstract
Objective The efficacy of tocilizumab (TCZ) in GCA is supported by two randomized controlled studies, in which TCZ allowed remission to be achieved after 52 weeks of treatment. However, after discontinuation of treatment, half of the patients relapsed. The aim of this study was to analyse the efficacy and safety of long-term treatment with TCZ and the role of fluorodeoxyglucose (FDG)-PET/CT scanning in the follow-up of these patients. Methods We collected the clinical data of a monocentric cohort of GCA patients retrospectively. Results Thirty-two patients were treated with TCZ [25 males and 7 females; age = 74 (59–81) years]. Most of them achieved and maintained clinical remission (1 month: 69%; 3 months: 91%; 6 months: 96%; 12 months: 100%), with serological and FDG-PET/CT scan improvement and a reduction of concomitant glucocorticoid therapy. Nineteen patients were treated for >52 weeks, and in 13 of them a dose tapering was performed, whereas in 2 cases TCZ was suspended for disease remission. Only two patients relapsed: one during TCZ tapering and one after TCZ discontinuation. Ten cases of mild infections and a case of urinary sepsis were reported; in patients treated for >1 year there was no increase in the incidence of side effects compared with patients treated for <12 months. Conclusion In our cohort of patients, we confirmed the efficacy of TCZ in the induction and maintenance of remission of GCA, demonstrating an important steroid-sparing effect and a good safety profile. Long-term treatment seems to prevent relapse of the disease, suggesting that TCZ treatment can be continued for >52 weeks with efficacy and safety.
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Affiliation(s)
- Francesca Regola
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia.,Department of Clinical and Experimental Sciences, University of Brescia
| | | | - Giovanni Bosio
- Nuclear Medicine Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia.,Department of Clinical and Experimental Sciences, University of Brescia
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia.,Department of Clinical and Experimental Sciences, University of Brescia
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia.,Department of Clinical and Experimental Sciences, University of Brescia
| | - Paola Toniati
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia
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545
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Kaymaz-Tahra S, Alibaz-Oner F, Direskeneli H. Assessment of damage in Takayasu's arteritis. Semin Arthritis Rheum 2020; 50:586-591. [PMID: 32470706 DOI: 10.1016/j.semarthrit.2020.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/11/2020] [Accepted: 04/13/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To assess the progression and the factors associated with damage in Takayasu's arteritis (TAK) patients during routine follow-up. METHODS Patients diagnosed with TAK and had >6 months follow-up were enrolled in this study retrospectively. Takayasu's arteritis damage score (TADS) and vasculitis damage index (VDI) were determined at diagnosis and at the end of the follow-up and variables associated with damage scores were assessed. RESULTS One-hundred fourteen patients (F/M: 101/13) were included in the study. The mean age at diagnosis, median symptom duration at baseline visit and mean follow-up duration were 35.3±13.3 years, 12 (0-360) months and 76.9±51.4 months, respectively. Median VDI score was 4.0 (1-8) and median TADS score was 7.0 (1-15) at baseline assessment. At the end of the follow-up, median VDI score increased to 5.0 (1-17) and TADS score to 8.0 (1-19). The median number of disease-related items were higher in TADS (8 items vs 4 items). At least one new corticosteroid (CS)-related damage item occurred in 35 patients (31%). Age at symptom-onset and cumulative CS doses were predictor factors for higher VDI score (≥5), whereas age at symptom-onset and disease duration were associated with increase in TADS (≥8). Gender and number of relapses were not associated with damage scores. CONCLUSION Damage assessment with VDI seems to capture treatment-related damage better, whereas TADS provides some additional information on disease-related damage in Takayasu's arteritis. Older age at symptom onset, disease duration and cumulative CS dose were associated with higher damage scores. The relapse frequency did not influence the damage level in our routine-follow-up of TAK patients.
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Affiliation(s)
- Sema Kaymaz-Tahra
- Division of Rheumatology, Department of Internal Medicine, Marmara University, Turkey.
| | - Fatma Alibaz-Oner
- Division of Rheumatology, Department of Internal Medicine, Marmara University, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Marmara University, Turkey
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546
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547
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Ponte C, Serafim AS, Monti S, Fernandes E, Lee E, Singh S, Piper J, Hutchings A, McNally E, Diamantopoulos AP, Dasgupta B, Schmidt WA, Luqmani RA. Early variation of ultrasound halo sign with treatment and relation with clinical features in patients with giant cell arteritis. Rheumatology (Oxford) 2020; 59:3717-3726. [DOI: 10.1093/rheumatology/keaa196] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/19/2020] [Indexed: 01/02/2023] Open
Abstract
Abstract
Objectives
To compare the ultrasound characteristics with clinical features, final diagnosis and outcome; and to evaluate the halo size following glucocorticoid treatment in patients with newly diagnosed GCA.
Methods
Patients with suspected GCA, recruited from an international cohort, had an ultrasound of temporal (TA) and axillary (AX) arteries performed within 7 days of commencing glucocorticoids. We compared differences in clinical features at disease presentation, after 2 weeks and after 6 months, according to the presence or absence of halo sign. We undertook a cross-sectional analysis of the differences in halo thickness using Pearson’s correlation coefficient (r) and Analysis of Variance (ANOVA).
Results
A total of 345 patients with 6 months follow-up data were included; 226 (65.5%) had a diagnosis of GCA. Jaw claudication and visual symptoms were more frequent in patients with halo sign (P =0.018 and P =0.003, respectively). Physical examination abnormalities were significantly associated with the presence of ipsilateral halo (P <0.05). Stenosis or occlusion on ultrasound failed to contribute to the diagnosis of GCA. During 7 days of glucocorticoid treatment, there was a consistent reduction in halo size in the TA (maximum halo size per patient: r=−0.30, P =0.001; and all halos r=−0.23, P <0.001), but not in the AX (P >0.05). However, the presence of halo at baseline failed to predict future ischaemic events occurring during follow-up.
Conclusion
In newly diagnosed GCA, TA halo is associated with the presence of ischaemic features and its size decreases following glucocorticoid treatment, supporting its early use as a marker of disease activity, in addition to its diagnostic role.
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Affiliation(s)
- Cristina Ponte
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon
| | - Ana Sofia Serafim
- Internal Medicine Department, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavai
- PhD in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Elisabete Fernandes
- Biomathematics Laboratory, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ellen Lee
- Clinical Trials Research Unit, ScHARR, The University of Sheffield, Sheffield
| | - Surjeet Singh
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
| | - Jennifer Piper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
| | | | | | | | - Bhaskar Dasgupta
- Department of Rheumatology, Southend Hospital NHS Trust, Westcliff-on-Sea, UK
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
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548
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Cid MC, Ríos-Garcés R, Terrades-García N, Espígol-Frigolé G. Treatment of giant-cell arteritis: from broad spectrum immunosuppressive agents to targeted therapies. Rheumatology (Oxford) 2020; 59:iii17-iii27. [DOI: 10.1093/rheumatology/kez645] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
Abstract
For decades, the treatment of GCA has relied on glucocorticoids. Work over the past two decades has supported a modest efficacy of MTX but no clear benefit from anti-TNF-based therapies. More recently, the therapeutic armamentarium for GCA has expanded. The availability of agents targeting specific cytokines, cytokine receptors or signalling pathways, along with a better, although still limited, understanding of the immunopathology of GCA, are opening further therapeutic possibilities. Blocking IL-6 receptor with tocilizumab has been effective in maintaining remission and reducing glucocorticoid exposure and tocilizumab has been approved for the treatment of GCA. However, nearly half of the patients do not benefit from tocilizumab and additional options need to be investigated. This review focuses on standard therapeutic approaches and on targeted therapies that have been or are currently under investigation.
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Affiliation(s)
- Maria C Cid
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Roberto Ríos-Garcés
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Nekane Terrades-García
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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549
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Sugihara T, Hasegawa H, Uchida HA, Yoshifuji H, Watanabe Y, Amiya E, Maejima Y, Konishi M, Murakawa Y, Ogawa N, Furuta S, Katsumata Y, Komagata Y, Naniwa T, Okazaki T, Tanaka Y, Takeuchi T, Nakaoka Y, Arimura Y, Harigai M, Isobe M. Associated factors of poor treatment outcomes in patients with giant cell arteritis: clinical implication of large vessel lesions. Arthritis Res Ther 2020; 22:72. [PMID: 32264967 PMCID: PMC7137303 DOI: 10.1186/s13075-020-02171-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background Relapses frequently occur in giant cell arteritis (GCA), and long-term glucocorticoid therapy is required. The identification of associated factors with poor treatment outcomes is important to decide the treatment algorithm of GCA. Methods We enrolled 139 newly diagnosed GCA patients treated with glucocorticoids between 2007 and 2014 in a retrospective, multi-center registry. Patients were diagnosed with temporal artery biopsy, 1990 American College of Rheumatology classification criteria, or large vessel lesions (LVLs) detected by imaging based on the modified classification criteria. Poor treatment outcomes (non-achievement of clinical remission by week 24 or relapse during 52 weeks) were evaluated. Clinical remission was defined as the absence of clinical signs and symptoms in cranial and large vessel areas, polymyalgia rheumatica (PMR), and elevation of C-reactive protein (CRP) levels. A patient was determined to have a relapse if he/she had either one of the signs and symptoms that newly appeared or worsened after achieving clinical remission. Re-elevation of CRP without clinical manifestations was considered as a relapse if other causes such as infection were excluded and the treatment was intensified. Associated factors with poor treatment outcomes were analyzed by using the Cox proportional hazard model. Results Cranial lesions, PMR, and LVLs were detected in 77.7%, 41.7%, and 52.5% of the enrolled patients, respectively. Treatment outcomes were evaluated in 119 newly diagnosed patients who were observed for 24 weeks or longer. The mean initial dose of prednisolone was 0.76 mg/kg/day, and 29.4% received any concomitant immunosuppressive drugs at baseline. Overall, 41 (34.5%) of the 119 patients had poor treatment outcomes; 13 did not achieve clinical remission by week 24, and 28 had a relapse after achieving clinical remission. Cumulative rates of the events of poor treatment outcomes in patients with and without LVLs were 47.5% and 17.7%, respectively. A multivariable model showed the presence of LVLs at baseline was significantly associated with poor treatment outcomes (adjusted hazard ratio [HR] 3.54, 95% CI 1.52–8.24, p = 0.003). Cranial lesions and PMR did not increase the risk of poor treatment outcomes. Conclusion The initial treatment intensity in the treatment algorithm of GCA could be determined based upon the presence or absence of LVLs detected by imaging at baseline.
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Affiliation(s)
- Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. .,Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiko Watanabe
- First Department of Physiology, Kawasaki Medical School, Kurashiki, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masanori Konishi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yohko Murakawa
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Noriyoshi Ogawa
- Department of Internal Medicine 3, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Yasuhiro Katsumata
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Taio Naniwa
- Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, Nagoya, Japan.,Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Okazaki
- Division of Rheumatology & Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.,National Hospital Organization, Shizuoka Medical Center, Shimizu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshikazu Nakaoka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Yoshihiro Arimura
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan.,Kichijoji Asahi Hospital, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.,Sakakibara Heart Institute, Tokyo, Japan
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550
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Mesquita A, Camara L, Patrício C, Brotas V. Boundaries of a systemic disease: a protean presentation of giant cell arteritis. BMJ Case Rep 2020; 13:13/3/e232234. [PMID: 32217659 DOI: 10.1136/bcr-2019-232234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old man was hospitalised with persistent fever, arm pain, dry cough and cholestasis. Diagnostic workup was remarkable for elevated inflammatory markers. Infectious diseases and autoimmune screening were negative. Imaging modalities excluded a neoplastic aetiology. Liver biopsy was negative for granulomatous or lymphomatous infiltrations. Giant cell arteritis (GCA) was suspected, but temporal artery Doppler ultrasound and biopsy were non-diagnostic. A positron emission tomography scan showed intense metabolic uptake in large vessels suggesting the diagnosis of GCA. Prednisolone was initiated with clinical and analytical improvement. At 1-year follow-up, there were no relapses and the patient remains symptom free.
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Affiliation(s)
- António Mesquita
- Internal Medicine, Hospital Santo António dos Capuchos, Lisboa, Portugal .,Pathophysiology Department, NOVA Medical School, Lisboa, Portugal
| | - Lara Camara
- Internal Medicine, Hospital Santo António dos Capuchos, Lisboa, Portugal
| | - Catarina Patrício
- Internal Medicine, Hospital Santo António dos Capuchos, Lisboa, Portugal
| | - Vítor Brotas
- Internal Medicine, Hospital Santo António dos Capuchos, Lisboa, Portugal
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